title: Two years of Finnish Telestroke: thrombolysis at spokes equal to that at the hub.
abstract: BACKGROUND
  Official guidelines on stroke promote the use of telemedicine via bidirectional videoconferencing equipment, which provides a valid and reliable means of facilitating thrombolysis delivery to patients in distant or rural hospitals.
  
  
  METHODS
  The present prospective cohort study describes the characteristics and 3-month outcome of the thrombolysis patients treated in 5 community hospitals served by the Helsinki University Central Hospital (HUCH) in a telestroke network during 2007 to 2009. The characteristics and outcome of telestroke thrombolysis patients are compared with consecutive thrombolysis patients (n = 985) treated at HUCH.
  
  
  RESULTS
  A total of 106 consecutive telestroke consultations in 2 years led to IV thrombolysis in 61 patients (57.5%). The median NIH Stroke Scale score was 10 (range 3-26), onset to treatment time 120 minutes (interquartile range [IQR] 49), length of consultation 25 minutes (IQR 18) if the consultation led to thrombolysis and 15 minutes (IQR 10) if not (p = 0.032). The rate of symptomatic intracranial bleedings was 6.7% (4/60) according to the National Institute of Neurological Disorders and Stroke definition. Half (28/57) of the thrombolysis patients with complete follow-up data had a favorable outcome (modified Rankin Scale [mRS] 0-2) and a third (17/57) had an excellent recovery (mRS 0-1). Thus the patients treated with thrombolysis based on teleconsultation had similar outcome with those treated at HUCH (mRS 0-2: 49.1% vs 58.1%, p = 0.214 and mRS 0-1: 17/57 [29.4%] vs 352/957 [36.8%], p = 0.289).
  
  
  CONCLUSIONS
  A special feature of the Finnish pilot is the high percentage of consultations leading to thrombolytic treatment with features and results very similar to on-site thrombolysis at the neurologic emergency room of HUCH.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland. tiina.sairanen@hus.fi
authors.forename: T
authors.initials: T
authors.lastname: Sairanen
authors.forename: S
authors.initials: S
authors.lastname: Soinila
authors.forename: M
authors.initials: M
authors.lastname: Nikkanen
authors.forename: K
authors.initials: K
authors.lastname: Rantanen
authors.forename: S
authors.initials: S
authors.lastname: Mustanoja
authors.forename: M
authors.initials: M
authors.lastname: Färkkilä
authors.forename: I
authors.initials: I
authors.lastname: Pieninkeroinen
authors.forename: H
authors.initials: H
authors.lastname: Numminen
authors.forename: P
authors.initials: P
authors.lastname: Baumann
authors.forename: J
authors.initials: J
authors.lastname: Valpas
authors.forename: T
authors.initials: T
authors.lastname: Kuha
authors.forename: M
authors.initials: M
authors.lastname: Kaste
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005387:Finland; D017408:Guidelines as Topic; D006764:Hospitals, Community; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D017216:Telemedicine / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D049269:Videoconferencing
chemical_list: D005343:Fibrinolytic Agents